| Background The morbidity of diabetes is increasing rapidly in whole world recent years. It has become a major public health problems because of the huge medical and economic burden. The prevelence of diabetes increases fast in China,too. In 2002, prevalence of diabetes in adult had reached 6.07% in China cities. According to International Diabetes Federation's statistic data in 2007, the number of diabetic patients in China is nearly 40 million, second only to India. Many studies found that cardiovascular disease is one of the important diabetic chronic complications and the main death cause in diabetic patients. The pathological basis of cardiovascular disease in type 2 diabetes is atherosclerosis. More than 80% death in diabetic patients is related to atherosclerosis, among which, 75% is caused by coronary heart disease. In all hospitalized patients because of diabetic complications, 77% is due to coronary artery disease. Diabetic patients combined with coronary heart disease are usually more serious than those without diabetes. The pathological progress of coronary heart disease in diabetic patients is more rapid too. And the age of onset of coronary heart disease is younger than non-diabetic patients. At the same time,many evidences prove that myocardial infarction in diabetic patients increse with the elevated blood glucose levels. Some data shows that prevelence of diabetic chronic complication reached 34.5% only when the diabetic duration more than 5 years. Some studies shows that only 70% of diabetic patients can survive after the first acute myocardial infarction, all of whom will have recurrence of infarction and the risk of sudden death increses to 200%.In the past,hyperglycemia, hypertension, obesity, dyslipidemia, microalbumin- uria and smoking were thought to be the major risk factors of macrovascular complications. In recent years,a large number of basic and clinical epidemiological studies found that matrix metalloproteinases played an important role in the formation of atherosclerosis and vascular reconstruction process in coronary heart disease,among which,matrix metalloproteinases-9 was related to coronary heart disease closely. Some researches indicate that matrix metalloproteinase -9 (MMP-9) express high in plasma and arterial wall in diabetic patients (especially patients with maicrovescular disease). Ankle-brachial ratio (also known as Ankle brachial index ,ABI) is considered the best non-invasive index in early diagnosis of lower extremity peripheral arterial disease and also a predict factor of mrobidity and motality of cardiovascular disease. There are few studies on the relationship between ABI and MMP-9 in type 2 diabeteic patients now in the worldwide. While because of the high incidence of cardiovascular disease based on atherosclerosis, clinical assessment of the risk of cardiovascular disease is particularly important. And early diagnosis and treatment can delay the occurrence and progression of cardiovascular disease in diabetes patients.Objective To investigate the clinical value of ABI and MMP-9 in evaluating degree and risk of cardiovascular disease in type 2 diabetes through detecting ABI and plasm MMP-9 and analysing the relationship betweeen the level of plasm MMP-9 and other cardiovascular risk factors and inally to provide an effective, simple, cheap means for clinical diagnosic.Methods 111 hospitalized type 2 diabetic patients undiagonise cardiovascular disease were selected from the department of endocrinology of the Second Hospital of Jilin University since December 2008 to December 2009. All the patients were diagnosed according to WHO 1999 diagnostic criteria; excluding those with acute infection (acute urinary tract infection, acute respiratory infections, etc.), acute diabetic comp- lications (such as diabetic ketosis, hyperosmolar coma, etc.), primary kidney disease, malignant hypertension, atrial fibrillation, bedreadin patients and those ABI> 1.3 patients. General state of health including age, gender, body mass index(BMI), blood pressure,history of smoking and coronary disease were recorded. The levels of plasm total cholesterol(TC), triglycerides(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), fasting blood glucose(FBG), microalbuminuria(MA), glycated hemoglobin (GHbA1c)were tested after fasting at least 12 hours in the morning. 12-lead electrocardiography and heart color doppler ultrasonograph were made in every patients. Ankle brachial indexes were measured by multi-purpose portable Doppler device (MD2 type, made by UK Huntleigh company) . According to the ABI values, 111 hospitalized type 2 diabetic patients were divided into 2 groups: 1)1.0≤ABI≤1.3 was normal group (50cases). 2) ABI<1.0 was abnormal group(61cases). All patients in the abnormal group were divided into three sub-groups according to different ABI values: A, 0.9≤ABI<1.0 as the critical state (29cases); B, mild to moderate peripheroartery disesase 0.4≤ABI<0.9 (21cases); C, serious peripheroartery disesase 0.0≤ABI<0.4 (11 cases). All cardiovascular risk factors and levels of MMP-9 were compared between normal ABI group and other three abnormal ABI groups. All data are expressed asˉx±s, and t test were made when comparing the diefference between two groups. Numeration data were expreed as percentage (%). Associativity analysis were made by linear correlation test. All statistical analysis were carried out in SPSS13.7 software package.Results (1) Among all 111 type 2 diabetic patients, ABI in 61 cases were below 1.0, accounting for 55%. In the abnormal ABI group: there were 29 cases in A group, 21 cases in B group, 11 cases in C group. There were 8 patients with coronary heart disease, ECG abnormal and heart color doppler ultrasonograph abnormal in ABI normal group, accounting for 16%; while 9 cases in group A, accounting for 31%; 10 cases in group B, accounting for 47.61%; and 8 cases in group C, accounting for 72.72%. Compared with ABI normal group, the incidence of cardiovascular disease increased in abnormal ABI group, especilly in group B and group C. (2) For smoking, there were 20 smoking cases in normal ABI group, accounting for 40%; 14 cases in group A, accounting for 48.27%; 15 cases in group B, accounting to 71.42%; and 9 cases in group C, accounting for 81.81%. Smoking rate in the three ABI abnormal groups were significantly more than in normal group; (3) Compared to ABI normal group, cardiovascular risk factors such as age, systolic and diastolic blood pressure, FBG, BMI, TG, TC, LDL-C, HDL-C, MA, GHbA1c in three abnormality groups were significantly different from the normal ABI group (p<0.05). With the reduction of ABI, age, diastolic blood pressure, FBG,TG, TC, LDL-C, MA, BMI, GHbA1c gradually increased, and negatively correlated to the ABI (r<-0.7); while with the ABI gradually reducing, HDL-C decreased too and was positively correlated with ABI (r>0.7). There were no significant difference in systolic blood pressure levels between ABI normal group and group A, group B, but they differed from group C significantly (p<0.05). There was no significant difference in sex among all the groups. (4) The levels of MMP-9 increaed significantly in all the three ABI abnormal groups than the normal ABI group (p<0.05). With the decreasing of ABI, the MMP-9 increased and was negatively correlated with ABI(r<- 0.7).Conclusions (1) Our data showed that even in ABI abnormal sub-group A, in which group ABI is between 0.9 to 1.0, previous thought as a critical state of atherosclerosis, MMP-9 and the risk factors of cardiovascular disease increased significantly (p<0.05). The result indicats that early prevention of cardiovascular risk factors in type 2 diabetes will play a key role in delaying the occurrence and development of chronic diabetic microvescular complications. (2) Our study showed that ABI were negatively correlated to MMP-9, ABI were negatively correlated to cardiovascular risk factors including age, diastolic blood pressure, FBG, BMI, TG, TC, LDL-C, MA and GHbA1c (r<-0.7), while positively correlated to HDL-C (r>0.7). The results indicates that prompt assessment of ABI can be a clinical marker to evaluate the severity of cardiovascular compliction in diabetic patients and to monitor the disease progress. (3) Being a non-invasive, inexpensive examination, ABI is easily accepted by patients. Even in remote, economically underdeveloped areas, the ABI examination is a useful and practical measure to screen the diabetic patients with high risk of cariovascular disease risk. ABI also can provide clinical evidence for prediction of these high risk patients. Only though early dignosis and prevention, reduction of morbidity and mortality of cardiovascular disease in type 2 diabetic patients will bacome possible and applicable.
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